Download PDF
Semin Respir Crit Care Med 2001; 22(4): 461-468
DOI: 10.1055/s-2001-17388
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Idiopathic Interstitial Pneumonias: The Role of Environmental Triggers

Paul Cullinan
  • Department of Occupational and Environmental Medicine, Imperial College (National Heart and Lung Institute), London, UK
Further Information

Publication History

Publication Date:
26 September 2001 (online)

    Permissions and Reprints

ABSTRACT

or cryptogenic-fibrosing alveolitis is defined by a cluster of clinical, radiological, functional, and pathological features as well as by the exclusion of a recognized ``cause.'' The processes by which clinicians assign causes to nonspecific diseases are complex and often subjective. Furthermore, the disease is comparatively rare and is generally diagnosed only after the use of specialized techniques. As a result, the study of its etiological factors is difficult and has been largely unrewarding.

The distribution of the disease, so far as it is understood, favors the elderly and, to a lesser extent, males. In some countries mortality has been rising, although it is not clear whether this can be attributed to a diagnostic shift. Studies of occupational classifications among patients dying with the disease offer no striking etiological leads.

Four potential etiologies have been formally studied: occupational dust exposures, cigarette smoking, prescription drug use, and viral infections. Three studies have indicated a role for wood and metal dust exposures; methodological issues, however, leave room for remaining doubt and these studies require verification in other populations. There is little epidemiological evidence that cigarette smoking contributes to the disease, or that therapeutic drug use plays an important part. The role of viral infections, particularly those related to Epstein-Barr virus (EBV), is intriguing but remains largely unsubstantiated.

KEYWORD

Idiopathic pulmonary fibrosis - epidemiology - mortality - occupation - smoking

REFERENCES

  • 1 Turner-Warwick M. In search of a cause of cryptogenic fibrosing alveolitis (CFA): one initiating factor or many?.  Thorax . 1998;  53 53-59
    PubMedGoogle Scholar
  • 2 Sharma O P, Chan K. Idiopathic interstitial pneumonitis/ fibrosis: a historical note.  Current Opinion in Pulmonary Medicine . 1999;  5 275-277
    CrossrefPubMedGoogle Scholar
  • 3 Hubbard R, Johnston I, Coultas D B, Britton J. Mortality rates from cryptogenic fibrosing alveolitis in seven countries.  Thorax . 1996;  51 711-716
    CrossrefPubMedGoogle Scholar
  • 4 Wells A U, Cullinan P, Hansell D M. Fibrosing alveolitis associated with systemic sclerosis has a better prognosis than lone cryptogenic fibrosing alveolitis.  Am J Respri Crit Care Med . 1994;  149 1583-1590
    CrossrefPubMedGoogle Scholar
  • 5 Johnston I, Britton J, Kinnear W, Logan R. Rising mortality from cryptogenic fibrosing alveolitis.  Br Med J . 1990;  301 1017-1021
    PubMedGoogle Scholar
  • 6 Coultas D B, Hughes M P. Accuracy of mortality data for interstitial lung diseases in New Mexico, USA.  Thorax . 1996;  51 717-720
    PubMedGoogle Scholar
  • 7 Harris J M, Cullinan P, McDonald J C. Occupational distribution and geographical clustering of deaths certified to cryptogenic fibrosis alveolitis in England and Wales.  Chest . 2001;  119(2) 428-433
    CrossrefPubMedGoogle Scholar
  • 8 Iwai K, Mori T, Yamada N. Idiopathic pulmonary fibrosis. Epidemiologic approaches to occupational exposure.  Am J Respir Crit Care Med . 1994;  150 670-675
    CrossrefPubMedGoogle Scholar
  • 9 De Vuyst P, Domortier P, Rickaert F. Occupational lung fibrosis in an aluminium polisher.  Eur J Respir Dis . 1986;  68 131-140
    PubMedGoogle Scholar
  • 10 Bartter T, Irwin R S, Abraham J L. Zirconium compound-induced pulmonary fibrosis.  Arch Intern Med . 1991;  151 1197-201
    CrossrefPubMedGoogle Scholar
  • 11 Townshend R H. Acute cadmium pneumonitis: a 17-year follow-up.  Br J Indust Med . 1982;  39 411-412
    PubMedGoogle Scholar
  • 12 Scott J, Johnston I, Britton J. What causes cryptogenic fibrosing alveolitis?.  <~>A case-control study of environmental exposure to dust. Br Med J . 1990;  301 1015-1017
    PubMedGoogle Scholar
  • 13 Hubbard R, Lewis S, Richards K, Johnston I, Britton J. Occupational exposure to metal or wood dust and aetiology of cryptogenic fibrosing alveolitis.  Lancet . 1996;  347 284-289
    CrossrefPubMedGoogle Scholar
  • 14 Hubbard R, Cooper M, Antoniak M. Risk of cryptogenic fibrosing alveolitis in metal workers.  Lancet . 2000;  355 466-467
    CrossrefPubMedGoogle Scholar
  • 15 De Cremoux R, Bernaudin J-F, Laurent P, Brochard P, Bignon J. Interactions between cigarette smoking and the natural history of idiopathic pulmonary fibrosis.  Chest . 1990;  98(1) 71-76
    PubMedGoogle Scholar
  • 16 Baumgartner K B, Samet J M, Stidley C A. Cigarette smoking: a risk factor for idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med . 1997;  155 242-248
    CrossrefPubMedGoogle Scholar
  • 17 Zitnik R J, Matthay R A. Drug-induced lung disease. In: Schwarz MI, King TE, eds. Interstital Lung Disease Hamilton, ON, Canada: BC Decker 1998: 423-449
    Google Scholar
  • 18 Blum R, Carter S, Agre K. A clinical review of bleomycin: a new antineoplastic agent.  Cancer . 1973;  31 903-913
    CrossrefPubMedGoogle Scholar
  • 19 Hubbard R, Venn A, Smith C, Cooper M, Johnston I, Britton J. Exposure to commonly prescribed drugs and the etiology of cryptogenic fibrosing alveolitis.  Am J Respir Crit Care Med . 1998;  157 743-747
    CrossrefPubMedGoogle Scholar
  • 20 Hubbard R, Venn A, Britton J. Exposure to antidepressants and the risk of cryptogenic fibrosing alveolitis: a case-control study.  Eur Respir J . 2000;  16 409-413
    CrossrefPubMedGoogle Scholar
  • 21 Egan J J, Woodcock A A, Stewart J P. Viruses and idiopathic pulmonary fibrosis.  Eur Respir J . 1997;  10 1433-1437
    CrossrefPubMedGoogle Scholar
  • 22 Vergnon J M, Vincent M, De The G. Cryptogenic fibrosing alveolitis and Epstein-Barr virus: an association.  Lancet . 1984;  ii 768-770
    PubMedGoogle Scholar
  • 23 Egan J J, Stewart J P, Hasleton P S. Epstein-Barr virus replication within pulmonary epithelial cells in cryptogenic fibrosing alveolitis.  Thorax . 1995;  50 1234-1239
    CrossrefPubMedGoogle Scholar
  • 24 Egan J J, Stewart J P, Hasleton P S. EBV PRC (Raji I) in idiopathic pulmonary fibrosis and sarcoidosis.  Am J Respir Crit Care Med . 1997;  155 A315
    PubMedGoogle Scholar
  • 25 Wangoo A, Nicholson A G, Diss T C. Cryptogenic pulmonary fibrosis does not appear associated with Epstein-Barr virus infection.  Thorax . 1996;  51(Suppl 3) A11
    PubMedGoogle Scholar
  • 26 Kuwano K, Nomoto R, Hagimoto N. Detection of adenovirus EIA in pulmonary fibrosis using nested polymerase chain reaction.  Eur Respir J . 1997;  10 1445-1449
    CrossrefPubMedGoogle Scholar
  • 27 Ueda T, Ohta K, Suzuki N. Idiopathic pulmonary fibrosis and high prevalence of serum antibodies to hepatitis C virus.  Am Rev Respir Dis . 1992;  146 266-268
    CrossrefPubMedGoogle Scholar
  • 28 Meliconi R, Andreone P, Fasano L. Incidence of hepatitis C virus infection in Italian patients with idiopathic pulmonary fibrosis.  Thorax . 1996;  51 315-317
    CrossrefPubMedGoogle Scholar
  • 29 Prieto J, Sangro B, Beloqui O. Ribavarin in desquamative interstitial pneumonia.  Chest . 1988;  93 446-447
    PubMedGoogle Scholar
  • 30 Agusti C, Xaubet A, Ballester E. Aerolised ribavarin in patients with advanced cryptogenic fibrosing alveolitis: a pilot study.  Thorax . 1993;  48 68-69
    PubMedGoogle Scholar
      >